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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 370 -373. doi: 10.3877/cma.j.issn.1674-3253.2019.06.003

所属专题： 经典病例； 经典病例； 文献；

病例研究·（最强挑战赛优秀病例）

转移性前列腺癌患者一例综合诊治报道并文献复习
杨春光1, 李拔森2, 梅齐3, 胡志全1,†()   
  1. 1. 430000　武汉，华中科技大学同济医学院附属同济医院泌尿外科
    2. 430000　武汉，华中科技大学同济医学院附属同济医院放射科
    3. 430000　武汉，华中科技大学同济医学院附属同济医院肿瘤科
  • 收稿日期:2019-02-11 出版日期:2019-12-01
  • 通信作者: 胡志全
  • 基金资助:
    国家自然科学基金(81702989)

The diagnosis and treatment of metastatic prostate cancer: a case repot and review of the literature

Chunguang Yang1, Basen Li2, Qi Mei3, Zhiquan Hu1,†()   

  1. 1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
    2. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
    3. Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
  • Received:2019-02-11 Published:2019-12-01
  • Corresponding author: Zhiquan Hu
  • About author:
    Corresponding author: Hu Zhiquan, Email :
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引用本文：

杨春光, 李拔森, 梅齐, 胡志全. 转移性前列腺癌患者一例综合诊治报道并文献复习[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(06): 370-373.

Chunguang Yang, Basen Li, Qi Mei, Zhiquan Hu. The diagnosis and treatment of metastatic prostate cancer: a case repot and review of the literature[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(06): 370-373.

目的

探讨转移性前列腺癌不同诊断治疗手段的选择和时机。

方法

回顾性分析1例转移性前列腺癌患者的临床资料，复习相关文献并予以讨论。患者，男，65岁，因"耻骨区疼痛伴尿频3月"入院。血PSA>1 000 μg/L。前列腺穿刺活检：双侧均为前列腺腺癌，Gleason评分8分（4+4），临床分期T4N0M1b。

结果

患者接受了去势+比卡鲁胺治疗17个月后进展为去势抵抗性前列腺癌，阿比特龙治疗原发耐药，行基因检测后接受了盆腔放疗和多西他赛化疗，随后病情缓解。

结论

对于转移性前列腺癌患者，内分泌治疗是综合治疗的基石，局部放疗和多西他赛化疗有利于缓解临床症状和延长患者生存期，基因检测对个体化治疗方案的制定有一定指导价值。

关键词: 前列腺癌, 转移性, 多模式治疗, 基因检测, 化疗
Objective

To explore the choices and timing of treatment regimens of metastatic prostate cancer.

Methods

The clinical data of a patient of metastatic prostate cancer was reported. The patient, aged 65 years, was admitted to hospital with pubic region pain and urinary frequency and dysuria for 3 months. Serum total prostate specific antigen (PSA) was more than 1 000 μg/L. So prostate biopsy was performed and Gleason score was 4+4, the clinical stage was T4N0M1b.

Results

The patient underwent combined androgen blockade (castration and bicalutamide) for 17 months. After progressing to castration-resistant prostate cancer (CRPC), the patient showed primary resistance to abiraterone. At the prompt of the genetic test results, the patient received pelvic radiotherapy and docetaxel chemotherapy, showing partial response.

Conclusions

For patients with metastatic prostate cancer, endocrine therapy is the cornerstone of comprehensive treatment. Local radiotherapy and docetaxel chemotherapy are beneficial to alleviate clinical symptoms and prolong the survival of patients. Genetic testing may guide individualized treatment plan.

Key words: Prostate cancer, Metastasis, Multi-modal therapy, Genetic testing, Chemotherapy
图1 2016年6月至2018年11月经各种治疗后血t-PSA水平
表1 基于二代测序技术的基因检测所示的本例患者基因突变
基因 位置 碱基变异 氨基酸变化 突变丰度 突变类型
TP53 chr17:7578461 c.469G>T p.Val157Phe 9.87% 错义突变
NFE2L2 chr2:178096576-178096578 c.753_755delGGA p.Glu251del 13.56% 非移码缺失
KMT2D chr12:49443623 c.3748C>G p.Pro1250Ala 11.36% 错义突变
FAT1 chr4:187629940 c.1042T>C p.Ser348Pro 8.75% 错义突变
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